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BUSINESS CERTIFICATE# 10-QUAD­ <br /> 711E COjIVIWNIVEALTH OF AIASSACHUSETTS <br /> TO FVN OF MASHPEE , v <br /> DATE �a - 2 � <br /> Expiration Date: Deeember 31, 2014 <br /> hi conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declare(s)that a business under the title of <br /> I \� - <br /> yS�IN �tCY� l �7a-,J FkStt-�DBA FfSHZie� tE(-eUf-)r,f C is conducted at <br /> I <br /> Business Location: �?_ (0 <br /> i Business Mailing Address: P e a U O r <br /> R-D . <br /> Business Type: E 2 C LA tJI Business Telephone: <br /> Home Phone: 5016 'A77 00 6-I b <br /> by the following named persons: <br /> \\ FULL NAME RESIDENCE <br /> �IUSrfN CisY4p ) FL -ecatnor P-p <br /> iZt,\n-e/yi- ANt imi Fi s KQ tP-- a P-e O uor R.D <br /> I certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> Des as required under law. <br /> *Signaure of authorized agent *Signature of authorized agent <br /> "*Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: i7 I S t A-0-R— TELEPHONE NUMBER: 569 f'(7? S c y t <br /> Alarm Company: <br /> *This license will not be issued unless this certification is signed by applicant <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C, Section 49A. <br /> The Commonwealth ofAlassachusells Y a <br /> BtVh\'STABLE ss 1r DATE �- <br /> Personally appeared before me the above-named V4t(I W f-r S pGte_ t 46'�t iCtckcmitnd made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years thereafter so long as such bus ess all be nducted and shall lapse and be void unless so renewed. <br /> igned �rJ <br /> i otary �yK <br /> HF a <br /> SEAL �,p1�1pNWEKiH OF Wh►R91tCN1KE>t» <br /> MvCWvrjssjmE)tpires <br /> Comm <br />